continuous quality improvement plan - highfields
TRANSCRIPT
Continuous Quality Improvement Plan
Revised February 2020
This plan outlines the standards and processes that Highfields has adopted to demonstrate its
commitment to offering the highest quality services by always seeking ways to improve.
Questions or comments regarding this plan and its contents can be directed to the Director
of Quality and Education
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Continuous Quality Improvement
Plan
Table of Contents
Introduction ………………………………………………………………...2
History ……………………………….………………………………2
Philosophy ………………………….………………………………2
Stakeholders ………………………………………………………………..2
Groups ……………………………….…………………………...…3
Involvement .……………………….………………………………3
CQI Structure ...……………………………………………………………..5
Model of Change ………………………………………………………….7
Process ……………………………………………………………………….8
Measures ...…………………………………………………………………..9
Client Outcomes …………………………………………………10
Quality Service Delivery …………………………………………11
Management & Operations Performance …………..…….12
External Review Processes ……………………………………..12
Appendix
CQI Committee Members ………………………………………………14
Samples of Quarterly Reports …………………………………………..14
Dashboard of Programs ………………………………………..15
Timeliness Scorecard ……………………………………………16
Risk Management Review ……………………………………..17
Case Record Review ……………………………………………21
Highfields Improvement Plan Template ……………………………..22
Contracted Outcomes & Outputs…………………………………….23
Mission Statement
To provide
opportunities to
children, youth and
families to become
more responsible for
their own lives and to
strengthen their
relationships with
others.
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Introduction
History
Highfields, Inc. began in 1962 as a residential camp for troubled boys in Ingham County. Our
founders truly believed that with the right opportunities and resources, people can change
their lives for the better. Since then, we have grown into a multi-purpose, human services
organization that touches more than 8,000 people each year. We operate out of five offices
to provide a wide array of counseling, intervention, training and support services to children,
youth, parents, families and organizations throughout Michigan.
Our organization has three main divisions: Community Services, Educational Services and
Residential Services. Details about the programs offered under each division can be found on
our website: www.highfields.org.
Philosophy
Continuous Quality Improvement (CQI) is an essential part of Highfields services. As an
organization, Highfields highly values employee and stakeholder involvement in carrying out
the agency’s mission, vision, goals, and desired outcomes. Highfields is committed to adhering
to all expectations of its quality improvement plan. This includes adherence to the rules,
expectations and guidelines of State of Michigan licensing standards, Council on
Accreditation for Children and Family Services standards, Michigan Department of Health and
Human Services, corporate compliance regulations, and privacy and security guidelines.
As Highfields has grown both geographically and programmatically, our CQI processes have
also evolved to embrace the challenges and opportunities of an increasingly diverse agency.
Under the leadership of the Director of Quality and Education (Q&E), Highfields collects data
from a variety of internal and external sources to promote positive changes throughout the
agency. The CQI Committee, which was formed in 2005 and consists of a range of Highfields
staff, plays an important role in collaborating to address ways the agency may improve its
services. Highfields prides itself on a culture of open communication and collaboration, which
is vital to successfully promoting any quality initiatives. In the spirit of collaboration, please feel
free to contact the Director of Q&E with any feedback on our CQI Plan.
Stakeholders
Through the variety of programs that Highfields offers, we touch many lives and have many
different stakeholders. Stakeholder groups and how they are involved are detailed in the
following section.
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Stakeholder Groups
Clients – The children, youth, and families who are served by Highfields programs
Referring Agencies – Agencies that refer clients to Highfields services, which may include
Michigan Department of Health and Human Services (MDHHS), Community Mental Health
Authorities, Courts, and a range of other human service organizations
Client Advocates – Groups that advocate on behalf of children, youth, and families such as
the Michigan Federation for Children and Families, Michigan Home-Based Family Services
Association, Michigan Association for Infant Mental Health, and others
Community Members – Members of the communities in which Highfields provides services
Employees – Staff of Highfields, including all offices and programs
Leadership Team – Staff of Highfields fulfilling leadership and supervisory roles
Board Members – Members of Highfields’ governing body
Donors – Generous supporters of Highfields’ mission and services
Stakeholder Involvement
Highfields values input from all stakeholders in realizing our mission. In addition to formal
processes that elicit feedback, Highfields embraces a philosophy of open communication.
Stakeholders should feel free to contact the agency at any time to share their thoughts and
be heard. Diagrams on the following pages illustrate the central feedback loops currently in
place to ensure important information is transmitted between the agency and it stakeholders.
Re
ferrin
g
Ag
en
cie
s
Hig
hfie
lds
Clie
nts
Clients have access to all of the public information
on Highfields’ website, including the Annual Report,
CQI Year-End Report, and other documents.
Clients complete Satisfaction Surveys at discharge
and are invited to provide feedback formally
during the planning process and at any time during
services. Client data is collected ongoing during
services and informs the CQI process.
Referring workers are asked to complete
Satisfaction Surveys at discharge. Site visits, case
readings, and formal audits take place
periodically. Formal and informal meetings also
encourage collaboration.
Highfields engages in presentations and meetings to
coordinate services and share feedback. Agencies
also have access to the reports on the website.
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Hig
hfie
lds
Em
plo
ye
es
Agency Updates are provided via email at least
monthly, in person at Roundtable Meetings, and
through a quarterly employee newsletter. The results
of the Satisfaction Survey are shared with staff. Staff
is also recognized for their achievements at the
annual Employee Recognition Banquet.
Employees are invited to share feedback and take
part in planning and problem solving processes at
regularly occurring meetings, including: Agency
Roundtable, Divisional Roundtables, Committee,
and team meetings. Employees complete a
Satisfaction Survey annually.
Clie
nt
Ad
vo
ca
tes
Through involvement with Michigan Federation for
Children and Families, Michigan Home-Based
Family Services Association, and other groups
Highfields receives helpful information about trends
and happenings that may affect our clients.
Highfields shares information with these groups
through involvement in periodic meetings, trainings,
conferences, and other opportunities for
collaboration.
Co
mm
un
ity
Me
mb
ers
Community members can share input with
Highfields at Neighborhood Watch meetings in
Onondaga or by reaching out at any time.
Highfields engages with community members at
Neighborhood Watch meetings and through
distribution of newsletters and the website.
Lea
de
rship
In addition to the information all employees receive,
Leadership Team is also given quarterly updates on
CQI Initiatives and measures including the Programs
Dashboard and Timeliness Scorecard. Leadership
may also receive information as it pertains to
helping to implement CQI or compliance initiatives.
Leadership Team has the same opportunities as
employees to give feedback. They also participate
in Leadership meetings where strengths and
challenges among programs can be addressed.
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CQI Structure
The structure of Highfields CQI program has evolved over time, including which staff within the
agency plays key roles. At this time, the central figure in the CQI structure is the Director of
Q&E, whose role is to promote professional excellence and continuous improvement in
programming through the coordination of education and staff development; and the
administration of evaluation measures of contracts, licensing and accreditation, corporate
compliance, and HIPAA standards.
The Director of Q&E is responsible for the following essential CQI tasks:
Organize and chair quarterly CQI Committee Meetings
Develop and coordinate outcome and evaluation programs
Collect and analyze data from programs and surveys
Compose and distribute quarterly quality reports, including:
o Dashboard of Programs
o Timeliness Scorecard
o Risk Management Review
o Case Record Reviews
Communicate significant quality matters with leadership
Bo
ard
Me
mb
ers
Board Members participate in bi-monthly board
and board committee meetings, including
Program, Fund Development, Personnel and
Finance, Building and Sites, Executive, and
Endowment Committees.
Board Members complete orientation at the start of
their term and are provided agency updates via
email and in person at board and committee
meetings. Board Members have opportunities to
attend events such as Ingham Academy
Graduation, the Strengthening Families Breakfast,
and Thanksgiving at the residential campus.
Do
no
rs
Invitations to share feedback are included in many
of the publications as well as quarterly pledge
statements that donors receive. Highfields will
occasionally complete a donor survey, although it
is not done on a regular schedule.
Donors are mailed the Highfields Annual Report,
and invited to participate in a range of fundraising
activities that include updates from the agency.
These include the Golf Outing, Garden Gala, and
Strengthening Families Breakfast.
Hig
hfie
lds
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Serve as a resource to staff and supervisors when corrective action is required
Compose the CQI Year-End Report
Develop and revise the CQI Plan with support from the CQI Committee
Act as primary contact for the Council on Accreditation
The CQI Committee meets on a quarterly basis, but can be convened more frequently should
the need arise. The committee was formed in 2005 and membership may vary, though there is
typically representation from the President or Vice President, Finance, Human Resources, North
Team Community Services, South Team Community Services, and Residential Services. A list of
current CQI Committee members is included in the appendix. Standing agenda items include
reviewing the following CQI areas:
Quarterly quality reports (listed above; samples appended)
Mandatory training needs
Strengths and needs for programs
Recent or upcoming audits, inspections, or case reviews
Implementation of any Corrective Action Plans
The CQI Committee will also address any additional topics that have an impact on quality.
Stakeholders can suggest topics to include on the agenda at any time as needed.
The Director of Q&E together with the CQI Committee develops annual goals for the
committee to address over the course of the calendar year. In the spring of each year, the
Director of Q&E completes a CQI Year-End Report that summarizes the committee’s activities,
progress toward goals, and sets forth goals for the next year.
The diagram on the following page helps to visually show the structure in which Highfields CQI
processes occur.
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Model of Change
Historically, Highfields has utilized collaboration between Leadership Team, CQI Committee,
and Quality personnel (presently the Director of Q&E) to establish goals and plans for changes
and improvements. Goals and plans are set when the data reviewed in CQI Committee
reveal negative trends or when acute problems are identified at any level. The agency has
typically focused on developing a plan, monitoring the results, and implementing wider scale
changes under the guidance of this collaborative group.
In efforts to cultivate more consistency in the change and improvement process, Highfields is
beginning to adopt the Plan-Do-Study-Act (PDSA) Cycle. The PDSA Cycle closely resembles
the strategies the agency has typically utilized in the past but provides added clarity for follow
through and uniformity. Each step of the PDSA Cycle is further defined in the subsequent
diagram. These will be the questions posed and steps completed when approaching problem
areas. The diagram also refers to the Model for Improvement, which includes three questions
to support the use of the PDSA cycle. Highfields will use these questions as a supplement.
CQI Structure:
Stakeholders communicate data that is ultimately analyzed by the Director of
Q&E before being shared with CQI Committee and Leadership. CQI
Committee uses data analysis to recognize excellence and identify problem
areas. As needed, CQI Committee prompts and tracks changes to address
problem areas. The Director of Q&E mediates the sharing of information
between CQI Committee and Leadership. Leadership assists with
implementing and communicating changes. Leadership ultimately conveys
information about data and changes back to stakeholders.
Director of Quality
& Education
CQI Committee
Stakeholders
Leadership Team
Residential
Services
External Reviews
Financial Audits
Fire Inspections
Health Inspections
Licensing Reviews
Contract Reviews
Other
Inspections/Reviews
as needed
Internal Reviews
Outcomes
Client Satisfaction
Employee Satisfaction
Case Record Review
Service Delivery
Outputs
Personnel Policy
Training
Risk Management
Restraints
Critical Incidents
Grievances
Medication
Dispensation
Environmental Risks
Mandatory Reporting
Work Place Safety
Community
Services
Educational
Services Administration
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Moen, R. D., & Norman, C. L. (2010). Circling Back. Quality Progress, 22-28. Retrieved May 14, 2018, from
https://deming.org/explore/p-d-s-a
There will be a learning curve as Highfields begins to integrate this formal model into its
processes. A template for improvement plans incorporating the model will be utilized when
internal corrective action or quality improvement plans are required. The Director of Q&E is
responsible for educating the CQI Committee and Leadership Team on the model and
revisiting it regularly. The CQI Committee and Leadership Team will act as ambassadors to
support the model in practice and encourage its use as a part of the improvement culture
and routine.
CQI Process
The CQI Process begins with data from stakeholders. Data is collected through various means,
including the use of ongoing internal and external monitoring and risk management reviews.
Data is often collected within divisions then sent to the Director of Q&E for analysis. The
Director of Q&E prepares quarterly CQI reports based on this data, which are in turn reviewed
by the CQI Committee. Representatives from each division of Highfields also attend CQI
Committee meetings to provide additional details on results of internal and external
monitoring activities.
The CQI Committee assists in identifying areas that would benefit from corrective action or
improvement. Corrective action is called for when either an internal or external monitoring
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function has revealed that Highfields has not sufficiently met expectations. Expectations are
dictated by a range of factors, including but not limited to contracts, licensing regulations,
Medicaid requirements, and internal policies. Improvement plans may be called for when a
downward trend or challenge has been identified through internal observation, which may
result in the agency not sufficiently meeting expectations if left unaddressed.
Depending on the nature of the concern, the CQI Committee may identify a variety of
stakeholders to participate in the development of an improvement plan. For example, one or
more members of the leadership team may take the lead in developing a plan for their
particular program or a representative workgroup may be formed to address a more
widespread issue.
Once the individual or group responsible for the plan is identified, they develop an
improvement plan using the PDSA Cycle. An improvement plan template integrating the PDSA
Cycle is available to assist Highfields in fully adopting the model (see appendix). It is expected
that this template be utilized unless an external monitoring entity requests the use of another
template. The plan is monitored through completion by the CQI Committee. The PDSA Cycle
ensures that the plan will either bring about a resolution or trigger another plan if necessary.
As improvements are made and changes are formally adopted, the Director of Q&E facilitates
the sharing of information between the Leadership Team and the CQI Committee. Ultimately,
the Leadership Team is in charge of relaying changes and improvements back to the
stakeholders. The cyclical nature of the PDSA Cycle and stakeholder feedback loops ensure
that a culture of improvement is consistently sustained.
As noted, several CQI reports are updated on a quarterly basis for review at different meetings
and among a variety of stakeholders. At the end of the calendar year, annual data is
aggregated and analyzed for the purposes of the CQI Year-End Report. The Year-End Report
provides evaluation of Highfields’ progress toward its annual CQI goals, sets goals for the
coming year, summarizes stakeholder involvement with Highfields, and reviews the results of
external and internal monitoring. The report is wide ranging and helps all stakeholders to have
a clear snapshot of how the agency has performed, major accomplishments, and areas for
improvement. It is also available to all stakeholders as it is published publicly on the Highfields
website.
Measures
Highfields utilizes a range of metrics to gather and analyze data related to client outcomes,
meeting contract expectations, delivering high quality services, and ensuring robust internal
operations. While some benchmarks and other specifics may vary from program to program,
there are also several indicators that are measured across the agency, as summarized in this
section.
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Client Outcomes
In Community Services and Residential Services, information on client outcomes is collected at
discharge and at six and twelve months post discharge. Three month follow ups are
completed only when required by contract. Much of the data collected on Closing Forms and
Outcome Forms is driven by contract requirements (see Outcomes and Outputs in the
appendix), and assists Highfields in determining the agency’s compliance with requirements in
addition to the positive impact on clients. The information is collected directly from the family,
or in cases where appropriate, the referring worker. The following list captures the information
collected on Closing and Outcome Forms in Community and Residential Services:
In Residential Services, Pre- and Post- Grade equivalency is recorded at discharge. It should be
noted that this is not consistently recorded if the student is discharged prior to the testing being
completed. Various Pre- and Post- measures are used in Community Services programs. The
following tools are used for mental health services provided under the contract with LifeWays
Community Mental Health:
Child and Adolescent Functional Assessment Scale (CAFAS)
Preschool and Early Childhood Functional Assessment Scale (PECFAS)
Devereaux Early Childhood Assessment (DECA)
Which tool is utilized depends upon the age of the child receiving services. All of the above
tools are administered at intake, quarterly, and discharge.
The Family Maintenance Program and Parent Education programs utilize the Adult-Adolescent
Parenting Inventory (AAPI) at intake and discharge. Parenting Wisely also utilizes a pre- and
post- test as part of its evidence based curriculum, completed at intake and discharge.
Specific guidance on the administration of pre- and post- measures is provided to staff within
each program as appropriate.
Data Collected Disc
ha
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Po
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isc
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Re
sid
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s
Family self-report of success X X X X
Youth in school, job, and/or community services X X
Change in placement X X X
Involvement with Child Protective Services X X X
Psychiatric hospitalizations X X X
Arrests, adjudications and convictions X X X X
Pre- and Post- measures X X X
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Outcome Forms are distributed to program staff quarterly, who reach out to clients and
referring workers to ensure the data is collected. The aggregated results of Closing and
Outcome Forms are compiled in the Year-End CQI Report. Depending on specific program
requirements, some data points are also pulled quarterly and reviewed within the program
and/or as part of the quarterly Dashboard.
Reaching Higher, Highfields’ after-school program, is reviewed by an external evaluator each
school year to explore program outputs and outcomes in great depth. Because of the way
the program is designed, Highfields relies on this data for client outcomes, while still measuring
internal data on outputs described below.
Ingham Academy and Pride program outcomes are reviewed by the court through which the
services are contracted. Highfields has recently been collaborating with the court to develop
new quality procedures to increase attention to outcomes and quality service delivery in the
future.
Quality Service Delivery
Highfields tracks several indicators of high quality service delivery and adherence to contract
expectations. Many of these measures relate to program outputs and are reported on the
quarterly Dashboard. For example, several Community Services programs require a certain
number of contact hours with clients to meet best practices and contract expectations. The
average number of contact hours per client is measured against the contracted benchmark
each quarter.
Satisfaction surveys using a five point Likert scale are also completed by referring workers and
clients in Residential and Community Services. The results of the surveys are measured
quarterly in the Dashboard and annually in the Year-End CQI Report.
Other benchmarks, such as the Residential Census are averaged and measured quarterly.
Benchmarks related to Reaching Higher, Ingham Academy, and Pride programs have been
recently revised or are currently in the process of revision as part of CQI initiatives to improve
meaningful data collection. Other changes to what and how data is collected for the
quarterly Dashboard may occur through the CQI process. This will allow the Dashboard to
remain adaptive and relevant as Highfields and its services evolve.
Timeliness is another measure of quality service delivery measured both quarterly and
annually. Highfields calculates timeliness of all reports in Residential and Community Services
based on the number of reports submitted by the contracted due date. The percentages are
reported on the quarterly Timeliness Scorecard and summarized in the Year-End CQI Report.
Case record reviews are also performed regularly throughout the year and summarized with
any relevant trends quarterly. This allows the CQI Committee to examine aspects of the service
delivery process that may need revision on a quarterly basis.
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Management & Operations Performance
Highfields completes a Quarterly Risk Management Review that compiles information on use
of physical interventions, licensing/contract complaints, critical incidents, medication
administration, client grievances, employee grievances, employee injuries and environmental
safety. The quarterly reports are reviewed in CQI Committee and compiled at the end of the
year to provide a comprehensive look at annual trends.
The Human Resources team also coordinates the completion of an annual Employee
Satisfaction Survey. Results from the survey are reviewed in Senior Leadership, Leadership, CQI
Committee, and Board meetings. The results are also shared broadly at the Agency Round
Table meeting, where staff is invited to help problem solve and develop objectives to improve
any areas that were particularly low.
It should be noted that the quarterly Dashboard used to include some data points on
finances. However, after review among Senior Leadership and the CQI Committee, it became
clear that the data points did not actually give a good snapshot of financial performance
and a financial report is already reviewed regularly by Senior Leadership and the Board. The
CQI Committee agreed that the Director of Finance will provide information and data on
finances as appropriate during CQI Committee meetings rather than attempting to merge
finance data into the Dashboard.
For the past several years, Strategic Planning has been a process driven by the Board with
support from the Senior Leadership Team. The CQI Committee reviewed progress toward
strategic goals as part of their meetings. Highfields is currently revising Strategic Planning
procedures to incorporate more input from both employees and the Board. The CQI
Committee will continue to review the planning process and goals as part of its meetings to
monitor this aspect of management and operations performance.
External Monitoring
Throughout the year the agency works with various consultants to conduct external reviews.
External monitoring includes:
Licensing Reviews
Financial Audits
Contract Reviews
Health Inspections
Fire Inspections
Other inspections/reviews as needed
The indicators and measures that comprise each external review are subject to the conditions
of the particular contract, regulations, or program. Often times, the indicators are the same as
those reviewed in the previous sections. When possible, program supervisors, the Director of
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Quality & Education, and any other appropriate staff may assist with reviewing files to prepare
for a planned external review.
Each external review is scheduled by the appropriate program supervisor. Upon receiving the
outcomes of the review, the supervisor responds to the review and writes any necessary
corrective action plans. These reviews and plans are in turn submitted to the CQI committee
for review and oversight of implementation.
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Appendix
The following documents are appended to supplement the CQI Plan. Many of these are
meant to provide an example of CQI initiatives at Highfields and only reflect the timeframe
designated. Please note that more up to date information may be found in the most recent
CQI Year-End Report on the Highfields website or by contacting the Director of Quality &
Education.
2018 Members of the CQI Committee
Becky Womboldt, Director of Quality & Education, Mindfulness and Meditation Coordinator
(Committee Chair)
Tania Moore, Billing and Quality Specialist (Records Minutes)
Brian Philson, President/CEO
Tim Monroe, Vice President
Ed St. John, Director of Finance
Darryl Scott, Manager of Operations, Residential Services
Jennifer Houston, Home Based 0-3 Supervisor
Dave Leese, Community Services Coordinator, North Team
Joanna Hayes, Quality Manager, Ingham Academy and Pride
Sample Quarterly Reports
Examples of Dashboard of Programs, Timeliness Scorecard, Risk Management Review, and
Case Record Review reports are included on the next several pages.
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Uniform Guidance Audited (formerly A133)
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Improvement Plan Template
Highfields Improvement Plan
Corrective Action Plan Quality Improvement Plan
Developing your plan:
What are we trying to accomplish?
How will we know that change is an improvement? What are the measurable outcomes?
What change can we make that will result in an improvement?
I. Plan List action steps (include who, what, where, when):
What do you predict will happen?
What resources are needed?
What data needs to be collected?
When will you follow up to review?
II. Do Carry out the plan, gather data, and document observations.
Describe what happened, including any obstacles/unexpected findings:
III. Study Compare measured outcomes to predictions. Describe results, what worked well, what was
challenging, etc:
IV. Act Based on the outcomes of this plan, we will:
Adapt – modify the plan and repeat the cycle
Adopt – continue implementation of the change on a wider scale
Abandon – find a new approach and write a new plan
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Outcomes and Outputs Required by Contract
(Updated June 2018)
FTBS
o 95% of families receiving FTBS services will not require an out-of-home placement
during program participation.
o 90% of families completing services will not require an out-of-home placement within
6 months of case closure.
o 85% of families completing service do not require an out-of-home placement within
12 months of case closure
FRP
o 70% of the families served shall successfully complete four months of service
o 75% of the families served shall not have any Category I, II, III, preponderance of
evidence Protective Services for a 12 month period following placement of the
children in the family home.
o 70% of the families served shall not have a child removed from the family home and
placed in out-of-home care for a 12 month period following placement in the family
home.
o 90% of the families exiting services shall express satisfaction with the services
received.
Outreach
o The contractor will ensure that the client achieves at least 50% of identified
objectives in the Treatment Plan
Home-Based
o 60% of clients receiving Home-Based services will improve on at least one of three
CAFAS indicators (Meaningful and Reliable Improvement; Number of Severe
Impairments; Pervasive Behavioral Impairment) when comparing initial CAFAS
assessment to most recent CAFAS assessment.
o 50% of all clients receiving Home-Based services must have a Physical Health and
Wellness goal developed through the person-centered planning process and
integrated into their Individual Plan of Service.
FMP and PE
o 90% of the families served that were intact at the time of referral shall remain intact
upon completion of services.
o 80% of clients will show improvement in a minimum of two of the identified target
areas on the AAPI pre and post-test, or equivalent.
o 80% of referred families that complete services will not have a substantiated CPS
compliant within three months following completion of the services.